Published online March 1, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 650 (doi:10.1542/peds.2006-3041)

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Newman, T. B. Search for Related Content PubMed PubMed Citation Articles by Newman, T. B. Related Collections Allergy & Dermatology Social Bookmarking                         What's this?

LETTER TO THE EDITOR

Industry-Sponsored "Expert Committee Recommendations for Acne Management" Promote Expensive Drugs on the Basis of Weak Evidence

Thomas B. Newman, MD, MPH
Department of Epidemiology
University of California
San Francisco, CA 94143-0560

To the Editor.—

I have several concerns about the "Expert Committee Recommendations for Acne Management,"¹ published in Pediatrics in September 2006. First, the 2 authors are both associated with various companies that make acne products, including Galderma (which funded the work). Galderma makes Differin (adapalene), which is prominently and favorably discussed in the article. How were the members of the "expert committee" selected? What role, if any, did the sponsor have in their selection?

Second, the recommendations are poorly supported by evidence. The first recommendation listed is: "A topical retinoid should be the foundation of treatment for most patients with acne." I have always started with benzoyl peroxide, which is available over-the-counter and considerably less expensive. However, not one randomized trial comparing topical retinoids to benzoyl peroxide was cited to justify their recommendation. In fact, the few trials I could find that directly compared the two suggested that, if anything, benzoyl peroxide is superior.^2–4

Third, the article states that "[s]tudies comparing the potential for cutaneous irritation among topical retinoids have consistently shown that the adapalene molecule is best tolerated of the available retinoids (Fig 7)." Their Fig 7 consists of 2 graphs of "average score" by "measurement points" for 4 topical retinoids and white petrolatum; the legend describes it as: "Tolerability of topical retinoids: 21-day cumulative irritancy study in healthy volunteers." The average score on this graph is completely uninterpretable. What is the significance of a 1.5-point difference? Why study healthy volunteers rather than acne patients? The legend indicates that data for the figure are on file at Galderma Laboratories. In other words, readers of Pediatrics are being asked to recommend this expensive new medication on the basis of uninterpretable results on inappropriate subjects from an industry-sponsored, unpublished, unreviewed study.

Finally, the expert committee recommendations include no discussion of medication costs. At this writing (October 2006), Drugstore.com is offering 10% benzoyl peroxide gel (ZapZyt) at $4.99 for 30 g, compared with $99 for 45 g of 0.1% generic tretinoin and $121 for 45 g of 0.1% Differin. This sort of information is extremely relevant to practicing pediatricians and their patients with acne. Why was it omitted?

I am accustomed to seeing and discarding drug-promoting, industry-sponsored reviews in throw-away journals or sponsored journal supplements. It was disappointing to see one uncritically published in Pediatrics.

REFERENCES

1. Zaenglein AL, Thiboutot DM. Expert committee recommendations for acne management. Pediatrics. 2006;118 :1188 –1199[Abstract/Free Full Text]
2. Gupta AK, Lynde CW, Kunynetz RA, Amin S, Choi K, Goldstein E. A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4% in the treatment of moderate acne vulgaris of the face. J Cutan Med Surg. 2003;7 :31 –37[Web of Science][Medline]
3. Belknap BS. Treatment of acne with 5% benzoyl peroxide gel or 0.05% retinoic acid cream. Cutis. 1979;23 :856 –859[Web of Science][Medline]
4. Lyons RE. Comparative effectiveness of benzoyl peroxide and tretinoin in acne vulgaris. Int J Dermatol. 1978;17 :246 –251[Web of Science][Medline]

---

PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				T. B. Newman Universal Bilirubin Screening, Guidelines, and Evidence Pediatrics, October 1, 2009; 124(4): 1199 - 1202. [Full Text] [PDF]

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Newman, T. B. Search for Related Content PubMed PubMed Citation Articles by Newman, T. B. Related Collections Allergy & Dermatology Social Bookmarking                         What's this?